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OIG Monthly Highlights

Read about our top reports and investigations in February 2015
Informal Claims Not Properly Controlled at Oakland, California, VA Regional Office, 21 Percent of Claims Reviewed Not Processed, Some as Old as 2002
On July 10, 2014, the Office of Inspector General (OIG) received a request for assistance from the Under Secretary for Benefits (USB) to review allegations that the VA Regional Office (VARO) in Oakland, CA, had not processed nearly 14,000 informal requests. The allegation indicated some claims dated back to the mid-1990s. The same allegation was forwarded to OIG by Representative Doug LaMalfa, who also requested an OIG review. In addition, another complainant alleged that “informal claims” were being improperly stored. OIG immediately initiated an unannounced, onsite review at VARO Oakland and its Sacramento satellite office. OIG substantiated the allegations that VARO staff had not processed informal claims. OIG confirmed that staff had not properly controlled these claims documents, which were accidently found in a filing cabinet, during a construction project. OIG did not identify any current storage or control issues during their site visit. VARO management advised that a team assisting the Oakland Veterans Service Center had located approximately 14,000 informal claims, some of which dated back to the mid-1990s. VA considers an informal claim as any type of communication or action, indicating the intent to apply for one or more benefits, in accordance with existing laws. Management stated it counted the documents and actually identified 13,184 informal claims. Of these 13,184 informal claims, 2,155 required review or action by VARO staff. VARO management told OIG they had created a “special project team” to process the 2,155 informal claims and thought the task had been completed. However, in April through May 2014, VARO staff again “discovered” additional claims, some of which the VARO’s “special project team” had annotated as reviewed.

Review of Alleged Misuse of VA Funds to Develop the Health Care Claims Processing System

The VA Office of Inspector General (OIG) conducted this review in response to allegations received by our Hotline Division. We evaluated the merits of an allegation that Veterans Health Administration’s (VHA) Chief Business Office (CBO) violated appropriations law by improperly obligating over $96 million in medical support and compliance (MS&C) funds to pay for the development of the Health Care Claims Processing System (HCPS). We substantiated that the CBO knowingly violated appropriations law by improperly obligating a total of $92.5 million of MS&C appropriations to finance the development of HCPS. The difference between the alleged and substantiated amounts is due to an estimate cited by the complainant. Of the $92.5 million, the FSC spent approximately $73.8 million. However, $18.7 million still remains obligated. MS&C appropriations are only authorized for administering medical, construction, supply, and research activities. CBO’s misuse of MS&C appropriations occurred because the Deputy Chief Business Officer (DCBO) did not seek the required IT Systems appropriations to fund the development of HCPS. Though initiated by the former DCBO for Purchased Care, MS&C appropriations were used instead of requesting funding from the Office of Information and Technology (OI&T) in hopes of achieving a faster delivery of this new information system. The current DCBO allowed the expenditures to proceed unchecked. As a result, the CBO violated appropriations law when it improperly obligated about $92.5 million of MS&C appropriations to develop HCPS.
We recommended the Interim Under Secretary for Health establish oversight mechanisms, seek the return of all MS&C appropriations, de-obligate all current MS&C funds, and obtain appropriate funding for HCPS development. We also recommended that the Interim Under Secretary determine if appropriate administrative action should be taken against DCBO senior officials in the Purchased Care’s chain of command. The Interim Under Secretary for Health concurred with our findings and recommendations and plans to complete all corrective actions by September 30, 2015. We considered these planned actions acceptable and will follow up on their implementation.

On July 10, 2014, the Office of Inspector General (OIG) received a request for assistance from the Under Secretary for Benefits to review allegations that the VA Regional Office (VARO) in Oakland, CA, had not processed nearly 14,000 informal requests. The allegation indicated some claims dated back to the mid 1990s. The same allegation was forwarded to us by Representative Doug LaMalfa, who also requested an OIG review. In addition, another complainant alleged that “informal claims” were being improperly stored. We immediately initiated an unannounced, onsite review at VARO Oakland and its Sacramento satellite office. We substantiated the allegations that VARO staff had not processed informal claims. We confirmed that staff had not properly controlled these claims documents, which were accidently found in a filing cabinet, during a construction project. We did not identify any current storage or control issues during our site visit. VARO management advised that a team assisting the Oakland Veterans Service Center (VCS) had located approximately 14,000 informal claims, some of which dated back to the mid-1990s. VA considers an informal claim as any type of communication or action, indicating the intent to apply for one or more benefits, in accordance with existing laws. Management stated it counted the documents and actually identified 13,184 informal claims. Of these 13,184 informal claims, 2,155 required review or action by VARO staff. VARO management told us they had created a “special project team” to process the 2,155 informal claims and thought the task had been completed. However, in April through May 2014, VARO staff again “discovered” additional claims, some of which the VARO’s “special project team” had annotated as reviewed. After two months, VARO management created a tracking spreadsheet to determine which claims needed to be processed. VARO management determined staff (assigned to the special project team) had not processed 537 informal claims. At the time of our onsite review, we could not confirm the existence of the 13,184 informal claims, or which of them were the 2,155 claims needing review or action. We reviewed 34 of these newly “discovered” claims and found 7 (21 percent) remained unprocessed. While no claims in our sample dated back to the mid-1990s, some were as old as July 2002. We also found VARO staff had repeatedly reviewed these seven informal claims from December 2012 through June 2014 for various reasons, but took no additional action on them, as required. VARO staff did not maintain adequate records or provide proper supervision to ensure informal claims received timely processing. As a result, veterans did not receive consideration for benefits to which they may have been entitled. During our inspection, no current issues related to the lack of control and improper storage of informal claims documents came to our attention. We recommended the VARO Director complete and certify the review of the 537 informal claims, take appropriate action, and provide documentation to certify these actions are complete. Also, the Director should better enforce compliance with existing VBA and VARO policies pertaining to the processing of informal claims.

OIG Monthly Highlights

Read about our top reports and investigations in January 2015
OIG Identifies Top Five VHA Shortage Occupations To Meet Veterans Access, Choice, and Accountability Act Reporting Mandate
The Office of Inspector General (OIG) conducted a determination of Veterans Health Administration (VHA) occupations with the largest staffing shortages as required by Section 301 of the Veterans Access, Choice, and Accountability Act of 2014. OIG interpreted “largest staffing shortage” to encompass broader deliberation than simply the number needed to replace or backfill vacant positions. OIG performed a rules-based analysis on VHA data to identify these occupations. OIG determined that the five occupations with the “largest staffing shortages” were Medical Officer, Nurse, Physician Assistant, Physical Therapist, and Psychologist. This determination is the first of several OIG determinations on VHA occupational staffing shortages. OIG plans to incorporate additional data in future determinations to provide more detailed recommendations.

OIG Monthly Highlights

Read about our top reports and investigations in December 2014
Review Finds Physicians Did Not Thoroughly Assess Patients Before Renewing Opioid Prescriptions at Chillicothe, Ohio VA Medical Center The Office of Inspector General (OIG) conducted an inspection in response to allegations that physicians at the Chillicothe, OH, VA Medical Center (VAMC) prescribed opioid medications for patients they had never evaluated. In addition, patients were alleged to be at risk because no prescriber was monitoring them for adverse reactions, pain relief, or opioid abuse. OIG did not substantiate that physicians improperly prescribed opioid medications for patients whom they had not seen or examined. OIG did substantiate that physicians prescribed opioids for patients with whom they had no direct interaction, but this is not a violation of law or VA policy. OIG substantiated that physicians did not consistently document medication effectiveness prior to renewing prescriptions for patients at increased risk for adverse medication effects or diversion. OIG also found that physicians were not consistently documenting use of the Ohio Automated Rx Reporting System, a state prescription drug monitoring program. OIG did find that urine drug screens were routinely performed. According to Veterans Health Administration (VHA) policy, patients on chronic opioid therapy are to be evaluated every 1 to 6 months.